Ken Grauer

KEN GRAUER, MD is Professor Emeritus (Dept. Community Health/Family Medicine, College of Medicine, University of Florida in Gainesville). Dr. Grauer has been a leading family physician educator for over 30 years. During that time he has published (as principal author) more than 15 books and numerous study aids on the topics of ECG interpretation, cardiac arrhythmias, and ACLS. Dr. Grauer retired from practice in 2010 — however, he remains extremely active writing ECG/Arrhythmia books — making ECG videos — and actively participating in numerous on-line ECG teaching forums.

— In 2014, he published, "A 1st Book on ECGs-2014". This is an introductory book for beginning students in ANY medical field. The book is 118 pages — it is ALL in COLOR — and it serves as an excellent START for introducing the reader into the world of ECG interpretation (Sample pages available on amazon — www.ecg1stbook.com). An expanded ePub version is now available.

— His most complete ECG book = ECG-2014-ePub. The hard copy book version is more concise, consisting of 260 pages (pocket sized/spiral binding for easy reference — www.ecg2014.com).

Please check out these FREE on-line Resources:— Educational ECG BLOG (www.blogecg.com). Clicking on the INDEX Tab (in the upper right of each blog page) takes you to detailed contents of all material.— Video ECGs (www.videoecg.com) — including MANY hours of meticulously-made video narrations on topics such as Bundle Branch Block; AV Blocks; Arrhythmia Diagnosis and Arrhythmia Management. Many more videos are planned in the future — so stay tuned!

— Dr. Grauer's perspective as a Board Certified family physician educator and clinician with expertise in cardiology is truly unique. His books have been translated into 4 languages and have sold over 500,000 copies nationwide and internationally.

AMONG HIS OTHER ACCOMPLISHMENTS (www.ekgpress.com):— Principal Author of more than 75 scientific articles pertaining to cardiology or ACLS topics for family physicians.— Presenter at well over 300 major Conferences over the past 35 years on various cardiology topics for family physicians, nurses, and other primary care providers — including numerous keynote speaker invitations at national meetings.— Featured Speaker on over 40 medical videos / audiocassettes produced by the AAFP or Audio-Digest.— Author of ECG Review columns that have been published monthly in various family practice journals since 1983.

— Longterm service on Editorial Boards and as reviewer of medical books/articles for many primary care journals.— Recipient of numerous Awards for teaching excellence on a local, statewide and national level — including 3-time Residency Teacher of the Year; recipient of the Superior Accomplishment Award and TIP Award from UF (one of two physicians to first receive this latter award); 1st recipient of the FAFP Educator of the Year Award (in 1993); 1st Recipient of the national AAFP Exemplary Teaching Award for full-time faculty (in 1997); Charter Member of the Society of Teaching Scholars at UF College of Medicine; and Exemplary Teacher, UFCOM in 2007, 2008, 2009 and 2010.

— Presenter of numerous national ECG Workshops (including Advanced ECG Interpretation at the AAFP Scientific Assembly for 18 consecutive years in the past), and previous longterm teacher of the ECG Review for AAFP Board Review Courses.— Former ACLS State and National Affiliate Faculty. Dr. Grauer taught in well over 100 ACLS Provider Coures and has had a major role in developing the curriculum and teaching at numerous ACLS Instructor Courses over the years. He is a former member of the AHA Task Force for ACLS Testing, and a contributor in the past to the AHA ACLS Textbook.

— Language facility (comfortably conversational in French and Spanish; learning German; some knowledge of Italian, Hebrew ...).— Outside interests: Travel and Dance (all ballroom, Argentine tango) which he enjoys with his wife, and watching his 2 adorable grandchildren growing up.

Author Updates

A 28-year old man was found “down” in front of his house. There was a history of alcohol consumption. The patient was not lucid enough to answer questions. His initial ECG is shown in Figure-1.Is this acute pericarditis?What key piece of information is missing from the history?How would you interpret this ECG?Figure-1: Initial 12-lead ECG and long lead II rhythm strip obtained from a 28-year old man who was found “down” in front of his house. NOTE — Enlarge by clicking on the

Is the patient whose 6 limb leads are shown in Figure-1in VFib (Ventricular Fibrillation)?Can you tell from these 6 leads, even before you see the rest of his 12-lead ECG?Figure-1: Is this patient in VFib? NOTE — Enlarge by clicking on the Figure.If one simply looked at these 6 leads — it would be easy to think this patient had just gone into VFib. However, there is enough information on this limited tracing to tell that this is not the case.The presence of artifact is extrem

The long lead II rhythm strip shown in Figure-1 was diagnosed as showing 2nd-Degree AV Block, Mobitz Type II.Do you agree with that assessment? If not — What is your diagnosis?-----------------------NOTE: This is a difficultarrhythmia to interpret. That said, we present numerous Pearls on arrhythmia interpretation throughout our discussion that should be of value for interpreters of any level. Are you up for the challenge?-----------------------
Figure-1: Long lead II rhythm stri

The ECG in Figure-1 was obtained from a patient with new-onset chest pain. It was interpreted as showing LBBB (Left Bundle Branch Block). As a result, the provider thought — “impossible to tell if anything acute is going on because there is LBBB”.Do you agree with that assessment?Figure-1: 12-lead ECG from a patient with chest pain. How do you interpret this tracing? NOTE — Enlarge by clicking on Figures — Right-Click to open in a separate window.--------------

The ECG in Figure-1 was obtained from a 60-year old woman who presented to the ED (Emergency Department) with new-onset chest pain.The initial emergency care provider interpreted this tracing as showing complete RBBB ( = Right Bundle Branch Block). Do you agree? Are you concerned about anything else?Figure-1: 12-lead ECG from a patient with new-onset chest pain. How do you interpret this tracing? NOTE — Enlarge by clicking on Figures — Right-Click to open

The ECG and long-lead II rhythm strip shown in Figure-1 was obtained from a 58-year old man who was admitted to the hospital with a history of chest pain and “fatigue”.How would you interpret the tracing?Is there 3:1 and/or “high-grade” AV block?How many different types of conduction disturbances can you identify?Is there ECG evidence of a cause?What treatment is likely to be needed? Figure-1: 12-lead ECG with long lead II rhythm strip obtained from a 58-year old man with chest pain and fa

One of the reasons why I have decreased the frequency of my own ECG Blog posts — is that for the past few years I have actively been commenting on Dawn Altman’s ECG Guru site — as well as on many of the wonderful ECG posts put forth by Dr. Steven Smith on his most excellent blog site.
For those desirous of additional sources of detailed ECG commentary — I suggest you check out:The Instructors’ Collection of ECGs on Dawn’s ECG Guru site.Any of the superb

The ECG in Figure-1 was obtained from a 48-year old man who presented to the ED (Emergency Department) with a 3-day history of chest discomfort. It shows evidence of a MI (Myocardial Infarction).How would you “date” this MI?Which areas of the heart are involved?Figure-1: 12-lead ECG obtained from a 48-year old man with 3 days of chest discomfort. NOTE — Enlarge by clicking on Figures — Right-Click to open in a separate window.-----------------------------------

The ECG in Figure-1 was obtained from a man in his 50s, who presented with new severe chest pain.How would you interpret this­­ tracing?What area(s) of the heart are involved?What is the likely “culprit” artery?Figure-1: 12-lead ECG obtained from a man in his 50s with chest pain. What is the likely “culprit” artery? NOTE — Enlarge by clicking on Figures — Right-Click to open in a separate window.-----------------------------------------------------------Interpretation: The unde

The ECG in the Figure-1 was obtained from an otherwise healthy 20-year old man. The patient was asymptomatic. This ECG was obtained when an irregular heartbeat was noted on routine exam.How would you interpret this­­ tracing?Are these multifocal (multiform) PVCs?How certain are you of your answer?Figure-1: 12-lead ECG obtained from a previously healthy 20-year old man with an irregular heartbeat. Are these multiform PVCs? NOTE — Enlarge by clicking on Figure

The rhythm in Figure-1 was diagnosed as AFlutter (Atrial Flutter) with4:1 AV conduction. Do you agree?What could be done to confirm your answer?Figure-1: Lead II rhythm strip. Is this AFlutter? NOTE — Enlarge by clicking on the Figure.-----------------------------------------------------------Interpretation: As emphasized in ECG Blog #137 — the most common ventricular response to untreatedatrial flutter is with 2:1 AV conduction. But the next most common ventricular response

How would you interpret the rhythm in Figure-1? What is your differential diagnosis? Can you be sure of your answer from looking at this lead MCL-1 rhythm strip?Why is it important to know if this patient is on Digoxin?Figure-1: Lead MCL1 rhythm strip. Is this AFlutter or ATach? NOTE — Enlarge by clicking on the Figure.-----------------------------------------------------------Interpretation: The rhythm in Figure-1 is regular with a ventricular rate of ~115/minute. P waves ou

The rhythm in Figure-1 was diagnosed as AFlutter (Atrial Flutter). Do you agree? If so — Is there anything unusual about this rhythm strip?Figure-1: Lead MCL1 rhythm strip. Is this typical atrial flutter? NOTE — Enlarge by clicking on the Figure.-----------------------------------------------------------Interpretation: Atrial flutter is characterized by a special pattern of regular atrial activity that in adults almost always occurs at a rate of 300/minute (250-to-350/mi

The rhythm in Figure-1 was observed as a previously healthy young adult was being treated for his “palpitations”. He was hemodynamically stable at the time. Interpret the rhythm.What happened? Should what we see be cause for alarm?Figure-1: Lead II rhythm strip during treatment (obtained from a patient with palpitations). Should what you see be cause for alarm? NOTE — Enlarge by clicking on the Figure.-----------------------------------------------------------Note: Discussion

The ECG in Figure-1 was obtained from a 55-year old man who presented for emergency care with palpitations and fatigue. Blood pressure was 80/50 mmHg at the time this tracing was recorded.Is this VT (Ventricular Tachycardia)?How certain are you of your answer?Figure-1: 12-lead ECG obtained from a 55-year old man with palpitations. Is this VT? NOTE — Enlarge by clicking on the Figure.-----------------------------------------------------------Interpretation: The rhythm is a reg

The 12-lead ECG in the Figure was obtained from a hemodynamically stable older adult with new-onset “palpitations”. Is this VT (Ventricular Tachycardia)? How certain are you of your answer?Figure-1: 12-lead ECG obtained from an older adult with palpitations. NOTE — Enlarge by clicking on the Figure.-----------------------------------------------------------Interpretation: Although we are told that this patient was hemodynamically stable at the time this ECG was reco

The lead II rhythm strip shown in Figure-1begins with 3 sinus-conducted beats. There follows a run of a WCT (Wide-Complex Tachycardia). How certain are you that the run of WCT that begins with beat #4 is VT (Ventricular Tachycardia)?Figure-1: Lead II rhythm strip. How certain are you that the run of wide beats beginning with beat #4 is VT? NOTE — Enlarge by clicking on the Figure.-----------------------------------------------------------Interpretation: As stated, the first 3

The lead II rhythm strip shown in Figure-1 was obtained from an older adult patient on telemetry. Should the patient be immediately cardioverted?Figure-1: Lead II rhythm strip obtained from a patient on telemetry. NOTE — Enlarge by clicking on Figures — Right-Click to open in a separate window.-----------------------------------------------------------Interpretation: Although at first glance, this tracing prompted much concern on the telemetry unit — prompt car

The 12-lead ECG shown in Figure-1 was obtained from a 51-year old man with new-onsetchest pain. The patient has diabetes, and he continues to smoke.How would you interpret this ECG?What is the likely “culprit” artery?Figure-1: 12-lead ECG obtained from a 51-year old man with new-onset chest pain. What is the likely “culprit” artery? NOTE — Enlarge by clicking on the Figure.Although there is much artifact (especially in leads II and III) — this does not pre

The 3 successive lead MCL-1 rhythm strips that are shown in Figure-1 were obtained from a 56-year old man with dyspnea, but no chest pain.How would you interpret the rhythm?Figure-1: Lead MCL-1 showing 3 successive rhythm strips from a patient with dyspnea. Can you explain what is happening? NOTE — Enlarge by clicking on the Figure.Although there is slight distortion of some QRS complexes, and the ECG grid is not well seen — this is a fascinating tracing!
PEARL: As we h

How would you interpret the lead V1 rhythm strip shown in Figure-1?How certain are you of your diagnosis?How would you describe this rhythm in words?Why does beat #8 look so different from all other beats in this tracing?What clinical situation is commonly associated with arrhythmias such as the one shown here?Figure-1: Long lead V1 rhythm strip showing a changing rhythm. Can you explain what is happening? NOTE — Enlarge by clicking on the Figure.PEARL: 3 of the most Helpful

How would you interpret the lead II rhythm strip shown in Figure-1?How certain are you of your diagnosis?Are the P waves preceding beats #6 and #7 conducting?Challenge Question: How many different-shaped beats are there on this tracing?Figure-1: Long lead II rhythm strip showing a changing rhythm. Can you explain what is happening? NOTE — Enlarge by clicking on the Figure.Interpretation: This is a challenging case. The easiest way to approach the interpretation of more diffic

This 12-lead ECG was obtained from a 61-year old man who was seen by EMS for new-onset chest discomfort. How would you interpret this ECG? Should you call to activate the cath lab en route to the hospital?Figure-1: 12-lead ECG obtained from a 61-year old man with new-onset chest discomfort. Would you activate the cath lab for suspected acute anterior STEMI? NOTE — Enlarge by clicking on the Figure.Interpretation: There are a number of findings on this ECG that make it difficult no

------------------------------------------------------------------NOTE: This Blog post is a reproduction of Section 13.0 from my ECG-2014-ePub (www.ecg2014.com):------------------------------------------------------------------13.0 – Computerized ECG Interpretations:A frequent question that arises is, “How best to use (or not use) the computerized ECG interpretation?” Opinions vary. We feel the answer depends on the goals and experience level of the interpreter.Computerized ECG analysis systems

This 12-lead ECG (with accompanying long lead II rhythm strip), was obtained from a 44-year old man who presented to the ED (Emergency Department) with new-onset chest pain. He was hemodynamically stable at the time this tracing was recorded. If no other history was available — How would you interpret this ECG? What do you suspect is going on clinically?Figure-1: 12-lead ECG (with long lead II rhythm strip) obtained from a 44-year old man with new-onset chest pain. How would you i